What Does a Medical Coding Specialist Do?

Medical coding specialists play an essential role in the business of healthcare. Using alphanumeric diagnosis and procedure codes, they communicate critical information about medical conditions and treatments. Coders translate medical terminology into a standardized format, allowing information to be transmitted accurately and efficiently between healthcare providers and insurance payors.

Correct coding ensures proper recording of a patient’s medical conditions, verification of the provider’s services, and appropriate reimbursement by payors for those services. Additionally, codes are used to monitor public health threats, such as diabetes or measles outbreaks, to track provider performance and to identify potential areas of financial or medical fraud or abuse within the healthcare industry. When coding is done properly, patients, providers, and payors all benefit.

Medical coding specialists rely on their knowledge of anatomy, medical terminology, health conditions, and medications to assign diagnostic and procedural codes for each patient encounter. They must review a patient’s medical record and will, at times, talk to the patient’s healthcare provider or research payor policies to uncover missing information.

Medical coding is a dynamic occupation, as evidenced by the health care community’s implementation of the ICD-10 code set as of October 1, 2015. ICD-10 is more advanced than the decades-old ICD-9 code set that it replaces, and the skills of medical coding specialists will be in greater demand than ever with this transition.

Workplace Details

Medical coding specialists work in a variety of settings, both clinical and non-clinical.

Clinical settings may include:

Hospitals

Physician offices and group practices

Surgery centers

Skilled nursing and other long-term care facilities

Dental offices

Home health agencies

Mental health facilities

Some medical coders work outside of the clinical setting at insurance companies, independent billing and coding services, consulting firms, public health organizations, and government agencies.

Most medical coding specialists work full time in a business office environment, spending a majority of their time abstracting clinical data from patient charts. They use a variety of resources to code correctly for services, supplies, and diagnoses, including the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codebooks; coding software; websites, such as InnerBody; and medical providers and colleagues.

While working hours for coders usually parallel business hours, some 24-hour facilities may schedule coders for evening or overnight shifts. In recent years, the number of at-home work opportunities, especially among non-clinical employers, has increased; however, these positions generally require several years of proven work experience.

Salary and Job Outlook

State

Average Wage

California

$48840

Texas

$39710

Florida

$40810

Ohio

$39000

New York

$45060

Hover over any state to explore local income and job growth data.

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The U.S. Bureau of Labor Statistics reports that the median annual salary for health information technicians (including medical coding specialists) is $38,040. The lowest paid 10% earn a median $25,070 while the highest paid 10% earn a median $62,840.

Meanwhile, according to Salary.com, the median yearly income of medical coding specialists is $57,501.

In 2013, AAPC estimated that coders who earned their Certified Professional Coder credential receive a median annual salary of $48,593, while those with higher credentials could expect higher earning potential (up to an average of $69,138). Experience, education and certification all increase a medical coder’s earning potential.

Medical coding specialists are in demand. According to the U.S. Bureau of Labor Statistics, job growth for medical records and health information technicians is expected to increase by 15% between 2014 and 2024, which is considered much faster than average for all occupations. This increase is partly due to the aging of our population; Americans will be using more and more healthcare services in coming decades. New regulations that require more accountability from healthcare providers are also creating jobs for qualified medical coding specialists.

Opportunities are greatest for candidates with mastery-level credentials (CCS or equivalent), those with several years of work experience and those with expertise in certain medical fields such as interventional radiology.

Medical coding jobs are posted on the websites of hospitals, health systems and other healthcare providers. The AAPC and Health Information Careers websites also list medical coding jobs. Because of the strong employment projections for health information professionals, those with an interest in the business of health care may want to consider a career as a medical coding specialist.

Compare Salaries by City

10th Percentile

50th Percentile

90th Percentile

Los Angeles CA Median Pay

$43050 Per Year

$20.69 Per Hour

New York City NY Median Pay

$46540 Per Year

$22.37 Per Hour

Steps to Become a Medical Coding Specialist

1

Earn your high school diploma.

Most employers look for a minimum of a high school diploma or equivalent. Not only that, but certification requires at least a high school diploma.

2

Determine whether you can train on the job.

In some cases, medical coding specialists may be trained entirely on the job. This can be an option for people who already have a strong background in health care or experience in other areas of health information. Additionally, the US Department of Labor (DOL) includes medical coding in its list of registered apprenticeship programs. An apprenticeship provides paid on-the-job training and academic instruction. For more information, see the US DOL website, or contact a state apprenticeship office or local chapter of the AAPC.

3

Start developing the necessary knowledge base.

Unless your circumstances qualify you to jump right in and train on the job, you will need to bolster your education in specific subjects before becoming a medical coder. While there are no mandatory educational requirements for employment, success as a medical coding specialist depends on a strong knowledge of biology, anatomy, physiology, and medical terminology. Most employers prefer candidates with a postsecondary certificate, associate degree, or at least a year of study beyond high school. O*Net estimates that 21% of health information technicians (including medical coders) have attended some college without earning a degree, while 20% hold an associate’s degree. The annual salary survey conducted by AAPC for 2014 indicates that almost 80% of its members have at least some postsecondary education.

4

Enroll in an approved program.

Programs in medical coding are available through community colleges, continuing education centers and four-year colleges, in both online and traditional formats. The core program takes about a year to complete, although additional supporting coursework in the sciences may be needed. Two professional organizations - the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC) - also offer online certificate programs.

A growing number of for-profit career schools offer certificate programs and associate degrees in medical coding; however, an investigation by the Government Accountability Office found that some of these programs engage in fraudulent or deceptive practices while charging very high tuition. To ensure a valid and appropriate education, research the program carefully, or consult the list of approved certificate programs on AHIMA’s website.

5

Get certified.

Certification as a medical coding specialist is voluntary, but well worth pursuing. Candidates with AHIMA or AAPC credentials are strongly preferred by employers, and often earn more than non-certified peers. In fact, AAPC estimates that coders holding a Certified Professional Coder (CPC) credential earn 20% more.

In addition to its entry-level CPC credential, AAPC offers certifications that demonstrate coding and/or health care business expertise in various settings and medical specialties. To become fully certified, candidates must, at a minimum, hold a high school diploma or equivalent, pass the certification exam, and have practical coding experience. AAPC specialty credentials require additional knowledge, additional work experience, or both.

AHIMA offers two levels of certification: the entry-level Certified Coding Associate (CCA) and the mastery-level Certified Coding Specialist (CCS). A high school diploma or equivalent is needed for the CCA certificate. Certification as a CCS or CCS-P (CCS Physician-Based) requires one of the following:

Completion of a coding training program

At least two years of experience in the field

CCA certificate and at least one year of experience in the field

Coding certificate from another certifying body and at least one year of experience

6

Advance your career.

Experienced medical coding specialists often supervise coding teams or serve as directors of coding at hospitals, health systems, or insurance companies. Due to the growing emphasis on accountability in health care, some organizations are even creating executive-level positions to direct coding strategy and operation. A bachelor’s or advanced degree in health information management or healthcare administration increases a coding specialist’s opportunities for advancement.

Explore Educational Paths

HIGH SCHOOL DIPLOMA

4 years

There are no education or certification requirements to work as a medical coding specialist. It’s therefore possible to train on the job if you find a willing employer.

That being said, it’s pretty tough to land a medical coding job with no education or credentials. Many people who do so have prior clinical or clerical experience in healthcare.

Some employers offer registered apprenticeships in medical coding. Apprentices receive on-the-job training and education. They’re also paid a salary, which increases with experience.

Coding apprenticeships last about a year. Upon finishing the program, you’ll receive a federal certificate of completion that’s portable anywhere in the country.

CODING CERTIFICATE

6 months-1 year

Medical coding is a highly competitive field. To break in and land better-paying jobs, it helps to have some formal education.

One option is a certificate course, a non-degree program that covers the following subjects:

Medical terminology

Learn vocabulary that will help you describe human anatomy, physiology, and disease processes.

Healthcare reimbursement

Familiarize yourself with the healthcare industry’s payment system, with emphasis on the importance of medical records.

Basic pathophysiology

Study the symptoms, risk factors, and treatments for a variety of diseases and conditions.

Diagnostic and procedural coding

Use the International Classification of Diseases to assign appropriate codes to medical records.

Many coding programs also include a practicum. This involves working as a coder under the supervision of an experienced professional. You can generally count practicum hours toward your experience requirement for certification

There are several types of programs that offer medical coding education:

Many community colleges, career colleges, and continuing education centers offer traditional and online certificate programs in coding.

The American Health Information Management Association (AHIMA) hosts a coding basics certificate course as well as short courses in clinical areas like neoplasms and the circulatory system. Learning is self-paced and can be delivered online or in a traditional classroom setting.

The AAPC offers an 80-hour coding certificate program with face-to-face and online learning options. They also offer additional courses in a variety of medical specialties and practice settings (for example, outpatient physician offices).

When deciding which program to attend, be on the look out for degree mills run by for-profit schools. These programs tend to be expensive while providing a low-quality education. You can download a list of approved certificate programs (including many online options) from AHIMA’s website.

ASSOCIATE DEGREE

2 years

There are several good reasons for medical coders to earn an associate degree (or higher) in the field:

Many employers prefer to hire coders with associate degrees

A two-year degree is also a good foundation if you later wish to earn a bachelor’s or graduate degree.

Coders with degrees are more likely to land higher-paying jobs and have greater lifetime earnings.

Having a degree may make it easier to land your first job without much experience.

So what should you get your degree in? One option is an AAS in medical coding and billing. However, if you choose this path, proceed with caution. There’s no industry-specific accreditor for this type of program, and many are offered by pricey for-profit schools. Get guidance from working coders or employers in your area before enrolling.

Another option (which is much better-regulated) is to earn a degree in health information management, or HIM. (It’s also called health information technology, or HIT, at some schools.)

HIM encompasses coding, but it also covers the broader management of health data and medical records. In addition to coding, a HIM degree will allow you to work in areas like quality assurance, auditing, compliance, informatics, and cancer registry.

Gain the skills and knowledge needed to run an effective health technology program.

ICD coding

Practice coding medical records according to official guidelines with the International Classification of Diseases as your reference.

CPT coding basics

Use the current procedural terminology (CPT) and HPCPS code sets to effectively communicate information about clinical services.

While it’s not required for most coding jobs, you can also earn a bachelor’s or graduate degree in HIM. This can be especially useful if you want to work in a management role or teach at the college level.

One caveat about HIM: since it’s not specific to coding, it might not thoroughly prepare you for your certification exams or your first coding job. Some HIM graduates therefore choose to complete additional coding training (or even a certificate program) before starting their coding careers.

Keys to Success as a Medical Coding Specialist

Necessary Skills and Qualities

Strong analytical skills

Medical coding rules are complex, and sometimes ambiguous.

Rigorous attention to detail

Coding specialists must be able to recognize key details in a patient record in order to apply the appropriate codes, or to know when additional information is needed.

Communication

Coders often act as liaisons between patients, providers, and payors, which requires the ability to communicate effectively, and they must be comfortable working and making decisions independently.

Comfort with technology

Computer skills are essential, especially in light of the increasing use of health informatics software and electronic health records.

Additional Credentials

Certification of medical coders is voluntary but preferred by many employers. AAPC estimates that certified coders earn 20 percent more than uncertified coders in the same setting.

When it comes to certification, there are tons of options. AAPC and AHIMA are the most widely recognized, but other credentials may be useful in certain geographic areas, settings, or specialties.

To decide which (if any) credential is best for you, talk with employers, working coders, or your academic advisor.

In order to earn the following AAPC credentials, you must meet experience and education requirements and pass a test.

Certified Professional Coder (CPC) – this is AAPC’s entry level, credential, which requires some work experience to obtain.

Apprentice Certified Professional Coder (CPC-A) – this coder has passed the CPC exam but is still working to meet the experience requirement.

Certifies an individual has the knowledge and skills necessary to lead a health information management program and serve as a resource for the organization. Candidates hold a bachelor’s degree or higher.

Popular Degree Programs

Related Career Paths

Authored by:

Karen Ewing, CPC, COBGC (AAPC), MT (ASCP)

Karen Ewing is a medical coding specialist working out of Madison, Wisconsin. She holds certifications as a certified professional coder, certified OB/GYN coder, and medical technologist. Karen has earned undergraduate degrees in biology, medical laboratory technology, and health care management.